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rVK UrrICE USE: 4 T ........................... APPLICATION FOR SANITATION PERMIT Permit No. ..75:'r/lU� . (Complete In Triplicate) .•.... This Permit Expires 1 Year From Doh Issued Date Issued . Application is hereby made to the San Joaquin Local Hea€th District fora permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRISS/LOCAT€ N .....0 4'1 ... 'I-k CES nS TRACT .......................... Owner's Name - .._..... ........... 0 .�.75�... ............. o e ................................ Address .... .. -- cit Contractor's Name _- -....License # ,.. Phone } Installation will serve: Residence ❑ApartmentHo e fl Commercial ❑Trailer Court I( Motel ❑Other---- ..A..f..I...... Number of living u nits: Number of bedrooms ............Garbage Grinder ............ Lot Size .....- Water Supply: Public System and name ..................... - .......... Private Character of soil to a depth of 3 feet; Sand 0 Silt Clay 0 Peat❑ Sandy Loam Clay Loan► D Hardpan. p C] Adobe ❑ Fill Material ............ If yes,type ............... (Plot .plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) NEW INSTALLATION: (No septic tank or seepage pit .permitted If public sewer.is available within 200 feet,¢ PACKAGE TREATMENT I } SEPTIC TANK Size. .................. Liquid Depth -•----_- Type...•....... _-- Matedal__:n':.. ••-_....... No. Compo .................... Capacity ----------- ----- Compartments r Distance. to nearest: Well .. ............ j ------......•----•..Foundation .......... ...•-•..... Prop. Line .............-----..:.,J LEACHING LINE [.I .No. of Lines --.....•---------- . " ---•-- Length of each line.......................... . Total Length ............................ ' D' Sox .......--..- Type Filter Material ------------------- -Depth .Filter Material .................... Distance to nearest: Well ........................ Foundation ........................ Property Line ..........................[/1 ` AGE PIT [ ) Depth Diameter SEEP_... Number Rock Filled Yes 0 No Water Table Depth0 ------------------------------------------------Rock Size .-...---•--•--------------•-- - Distance to nearest: Well ....................------_-_-------Foundation .................... Prop. line ...................... REPAIR/ADDITION(Prev. Sanitation Permit# ---.....---------------z ...---.-_--•- Date ---------------- - Septic Tank (Specify Requirements) ............ ............. ............................. sposal Field (Specify Requirements) .. -- ------ - --- ----- , ---------------------------------------------V�---A, - - . ----------- (Draw existing and required addition an reverse side-) ----------- -------•--. ...... ---................. I hereby certify that I have prepared this application and that the work wilf be done In accordance with San Joaquin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health:Dlstrlct. Hone owner or licen- sed agents signature certifies the following: "I certify that in the performance of the worts for which this permit is Issued, I shall not employ any person In such manner as to become subject to Workman's Compensation laws of California." Signed .. Owner -- - -•---- BY ••-------- Title (I oth than owner) ---•- ----------�---... .-- FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY -,-. - DATE g-.. ._----•-• ---------•-------.------•-----------------......... BUILDING PERMIT ISSUED ----------- ADDITIONAL COMMENTS -- --------------_.--_--.•---' - -•--- ..---• - ----------- - --•- --.DATE _. ...................................... --••------•-- •-- •----------•- �- -- -••---•--••-_•---..... . -------------------- -----------•-•----..._. ------------------................-•---------------------.......... --------------------------- ------------------ ." ...... ....................... -..-. _ Final Inspection by: ••-... .-..... Date . . _- - EH 13 2L 1-68 rev. SM SA � ---- •.............. N JOAQUIN LOCAL HEALTH DISTRICT 8/7h 3M